Cyclosporine for Ocular Inflammatory Diseases

R. Oktay Kaçmaz, John H. Kempen, Craig Newcomb, Ebenezer Daniel, Sapna Gangaputra, Robert B. Nussenblatt, James (Jim) Rosenbaum, Eric Suhler, Jennifer E. Thorne, Douglas A. Jabs, Grace A. Levy-Clarke, C. Stephen Foster

Research output: Contribution to journalArticle

139 Citations (Scopus)

Abstract

Purpose: To evaluate the clinical outcomes of cyclosporine treatment for noninfectious ocular inflammation. Design: Retrospective cohort study. Participants: A total of 373 patients with noninfectious ocular inflammation managed at 4 tertiary ocular inflammation clinics in the United States observed to use cyclosporine as a single noncorticosteroid immunosuppressive agent to their treatment regimen, between 1979 and 2007 inclusive. Methods: Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics, including dosage of cyclosporine and main outcome measures, were obtained for every eye of every patient at every visit via medical record review by trained expert reviewers. Main Outcome Measures: Control of inflammation, sustained control after reducing corticosteroid dosages, and discontinuation of therapy because of toxicity. Results: Of the 373 patients (681 eyes) initiating cyclosporine monotherapy, 33.4% by 6 months and 51.9% by 1 year gained sustained, complete control of inflammation over at least 2 visits spanning at least 28 days. Approximately 25% more improved to a level of slight inflammatory activity by each of these time points. Corticosteroid-sparing success (completely controlled inflammation for at least 28 days with prednisone ≤ 10 mg/day) was achieved by 22.1% by 6 months and 36.1% within 1 year. Toxicity led to discontinuation of therapy within 1 year by 10.7% of the population. Patients aged more than 55 years were more than 3-fold more likely to discontinue therapy because of toxicity than patients aged 18 to 39 years. Doses of 151 to 250 mg/day tended to be more successful than lower doses and were not associated with a higher discontinuation for toxicity rate; higher doses did not seem to offer a therapeutic advantage. Conclusions: Cyclosporine, with corticosteroid therapy as indicated, was modestly effective for controlling ocular inflammation. Our data support a preference for cyclosporine adult dosing between 151 and 250 mg/day. Although cyclosporine was tolerated by the majority of patients, toxicity was more frequent with increasing age; alternative agents may be preferred for patients aged more than 55 years. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

Original languageEnglish (US)
Pages (from-to)576-584
Number of pages9
JournalOphthalmology
Volume117
Issue number3
DOIs
StatePublished - Mar 2010

Fingerprint

Eye Diseases
Cyclosporine
Inflammation
Adrenal Cortex Hormones
Immunosuppressive Agents
Therapeutics
Cohort Studies
Outcome Assessment (Health Care)
Disclosure
Prednisone
Medical Records
Retrospective Studies
Demography
Population

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Kaçmaz, R. O., Kempen, J. H., Newcomb, C., Daniel, E., Gangaputra, S., Nussenblatt, R. B., ... Foster, C. S. (2010). Cyclosporine for Ocular Inflammatory Diseases. Ophthalmology, 117(3), 576-584. https://doi.org/10.1016/j.ophtha.2009.08.010

Cyclosporine for Ocular Inflammatory Diseases. / Kaçmaz, R. Oktay; Kempen, John H.; Newcomb, Craig; Daniel, Ebenezer; Gangaputra, Sapna; Nussenblatt, Robert B.; Rosenbaum, James (Jim); Suhler, Eric; Thorne, Jennifer E.; Jabs, Douglas A.; Levy-Clarke, Grace A.; Foster, C. Stephen.

In: Ophthalmology, Vol. 117, No. 3, 03.2010, p. 576-584.

Research output: Contribution to journalArticle

Kaçmaz, RO, Kempen, JH, Newcomb, C, Daniel, E, Gangaputra, S, Nussenblatt, RB, Rosenbaum, JJ, Suhler, E, Thorne, JE, Jabs, DA, Levy-Clarke, GA & Foster, CS 2010, 'Cyclosporine for Ocular Inflammatory Diseases', Ophthalmology, vol. 117, no. 3, pp. 576-584. https://doi.org/10.1016/j.ophtha.2009.08.010
Kaçmaz RO, Kempen JH, Newcomb C, Daniel E, Gangaputra S, Nussenblatt RB et al. Cyclosporine for Ocular Inflammatory Diseases. Ophthalmology. 2010 Mar;117(3):576-584. https://doi.org/10.1016/j.ophtha.2009.08.010
Kaçmaz, R. Oktay ; Kempen, John H. ; Newcomb, Craig ; Daniel, Ebenezer ; Gangaputra, Sapna ; Nussenblatt, Robert B. ; Rosenbaum, James (Jim) ; Suhler, Eric ; Thorne, Jennifer E. ; Jabs, Douglas A. ; Levy-Clarke, Grace A. ; Foster, C. Stephen. / Cyclosporine for Ocular Inflammatory Diseases. In: Ophthalmology. 2010 ; Vol. 117, No. 3. pp. 576-584.
@article{303c6ce3ecec4ef79a4a5dd07db4219c,
title = "Cyclosporine for Ocular Inflammatory Diseases",
abstract = "Purpose: To evaluate the clinical outcomes of cyclosporine treatment for noninfectious ocular inflammation. Design: Retrospective cohort study. Participants: A total of 373 patients with noninfectious ocular inflammation managed at 4 tertiary ocular inflammation clinics in the United States observed to use cyclosporine as a single noncorticosteroid immunosuppressive agent to their treatment regimen, between 1979 and 2007 inclusive. Methods: Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics, including dosage of cyclosporine and main outcome measures, were obtained for every eye of every patient at every visit via medical record review by trained expert reviewers. Main Outcome Measures: Control of inflammation, sustained control after reducing corticosteroid dosages, and discontinuation of therapy because of toxicity. Results: Of the 373 patients (681 eyes) initiating cyclosporine monotherapy, 33.4{\%} by 6 months and 51.9{\%} by 1 year gained sustained, complete control of inflammation over at least 2 visits spanning at least 28 days. Approximately 25{\%} more improved to a level of slight inflammatory activity by each of these time points. Corticosteroid-sparing success (completely controlled inflammation for at least 28 days with prednisone ≤ 10 mg/day) was achieved by 22.1{\%} by 6 months and 36.1{\%} within 1 year. Toxicity led to discontinuation of therapy within 1 year by 10.7{\%} of the population. Patients aged more than 55 years were more than 3-fold more likely to discontinue therapy because of toxicity than patients aged 18 to 39 years. Doses of 151 to 250 mg/day tended to be more successful than lower doses and were not associated with a higher discontinuation for toxicity rate; higher doses did not seem to offer a therapeutic advantage. Conclusions: Cyclosporine, with corticosteroid therapy as indicated, was modestly effective for controlling ocular inflammation. Our data support a preference for cyclosporine adult dosing between 151 and 250 mg/day. Although cyclosporine was tolerated by the majority of patients, toxicity was more frequent with increasing age; alternative agents may be preferred for patients aged more than 55 years. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.",
author = "Ka{\cc}maz, {R. Oktay} and Kempen, {John H.} and Craig Newcomb and Ebenezer Daniel and Sapna Gangaputra and Nussenblatt, {Robert B.} and Rosenbaum, {James (Jim)} and Eric Suhler and Thorne, {Jennifer E.} and Jabs, {Douglas A.} and Levy-Clarke, {Grace A.} and Foster, {C. Stephen}",
year = "2010",
month = "3",
doi = "10.1016/j.ophtha.2009.08.010",
language = "English (US)",
volume = "117",
pages = "576--584",
journal = "Ophthalmology",
issn = "0161-6420",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Cyclosporine for Ocular Inflammatory Diseases

AU - Kaçmaz, R. Oktay

AU - Kempen, John H.

AU - Newcomb, Craig

AU - Daniel, Ebenezer

AU - Gangaputra, Sapna

AU - Nussenblatt, Robert B.

AU - Rosenbaum, James (Jim)

AU - Suhler, Eric

AU - Thorne, Jennifer E.

AU - Jabs, Douglas A.

AU - Levy-Clarke, Grace A.

AU - Foster, C. Stephen

PY - 2010/3

Y1 - 2010/3

N2 - Purpose: To evaluate the clinical outcomes of cyclosporine treatment for noninfectious ocular inflammation. Design: Retrospective cohort study. Participants: A total of 373 patients with noninfectious ocular inflammation managed at 4 tertiary ocular inflammation clinics in the United States observed to use cyclosporine as a single noncorticosteroid immunosuppressive agent to their treatment regimen, between 1979 and 2007 inclusive. Methods: Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics, including dosage of cyclosporine and main outcome measures, were obtained for every eye of every patient at every visit via medical record review by trained expert reviewers. Main Outcome Measures: Control of inflammation, sustained control after reducing corticosteroid dosages, and discontinuation of therapy because of toxicity. Results: Of the 373 patients (681 eyes) initiating cyclosporine monotherapy, 33.4% by 6 months and 51.9% by 1 year gained sustained, complete control of inflammation over at least 2 visits spanning at least 28 days. Approximately 25% more improved to a level of slight inflammatory activity by each of these time points. Corticosteroid-sparing success (completely controlled inflammation for at least 28 days with prednisone ≤ 10 mg/day) was achieved by 22.1% by 6 months and 36.1% within 1 year. Toxicity led to discontinuation of therapy within 1 year by 10.7% of the population. Patients aged more than 55 years were more than 3-fold more likely to discontinue therapy because of toxicity than patients aged 18 to 39 years. Doses of 151 to 250 mg/day tended to be more successful than lower doses and were not associated with a higher discontinuation for toxicity rate; higher doses did not seem to offer a therapeutic advantage. Conclusions: Cyclosporine, with corticosteroid therapy as indicated, was modestly effective for controlling ocular inflammation. Our data support a preference for cyclosporine adult dosing between 151 and 250 mg/day. Although cyclosporine was tolerated by the majority of patients, toxicity was more frequent with increasing age; alternative agents may be preferred for patients aged more than 55 years. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

AB - Purpose: To evaluate the clinical outcomes of cyclosporine treatment for noninfectious ocular inflammation. Design: Retrospective cohort study. Participants: A total of 373 patients with noninfectious ocular inflammation managed at 4 tertiary ocular inflammation clinics in the United States observed to use cyclosporine as a single noncorticosteroid immunosuppressive agent to their treatment regimen, between 1979 and 2007 inclusive. Methods: Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Demographic and clinical characteristics, including dosage of cyclosporine and main outcome measures, were obtained for every eye of every patient at every visit via medical record review by trained expert reviewers. Main Outcome Measures: Control of inflammation, sustained control after reducing corticosteroid dosages, and discontinuation of therapy because of toxicity. Results: Of the 373 patients (681 eyes) initiating cyclosporine monotherapy, 33.4% by 6 months and 51.9% by 1 year gained sustained, complete control of inflammation over at least 2 visits spanning at least 28 days. Approximately 25% more improved to a level of slight inflammatory activity by each of these time points. Corticosteroid-sparing success (completely controlled inflammation for at least 28 days with prednisone ≤ 10 mg/day) was achieved by 22.1% by 6 months and 36.1% within 1 year. Toxicity led to discontinuation of therapy within 1 year by 10.7% of the population. Patients aged more than 55 years were more than 3-fold more likely to discontinue therapy because of toxicity than patients aged 18 to 39 years. Doses of 151 to 250 mg/day tended to be more successful than lower doses and were not associated with a higher discontinuation for toxicity rate; higher doses did not seem to offer a therapeutic advantage. Conclusions: Cyclosporine, with corticosteroid therapy as indicated, was modestly effective for controlling ocular inflammation. Our data support a preference for cyclosporine adult dosing between 151 and 250 mg/day. Although cyclosporine was tolerated by the majority of patients, toxicity was more frequent with increasing age; alternative agents may be preferred for patients aged more than 55 years. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article.

UR - http://www.scopus.com/inward/record.url?scp=77049113738&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77049113738&partnerID=8YFLogxK

U2 - 10.1016/j.ophtha.2009.08.010

DO - 10.1016/j.ophtha.2009.08.010

M3 - Article

C2 - 20031223

AN - SCOPUS:77049113738

VL - 117

SP - 576

EP - 584

JO - Ophthalmology

JF - Ophthalmology

SN - 0161-6420

IS - 3

ER -